Matthew James Midtling, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7269 Issued in WI

Practice address

840 N. 87TH Streeth
Sargeant Health Center
Milwaukee, WI 53226

Phone

(414) 805-5760

Fax

(414) 259-9115

NPI assigned

Mar 30, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 8, 2020 through Apr 8, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Milwaukee Oral Surgery & Implants LTD

  • Oral and Maxillofacial Surgery (Dentist)
  • Milwaukee, WI
  • NPI 1972550234
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412294400000",
    "number": "1497098255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 NORHARDT DR",
            "address_2": "#105",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455089",
            "telephone_number": "651-402-6593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 N. 87TH STREETH",
            "address_2": "SARGEANT HEALTH CENTER",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53226",
            "telephone_number": "414-805-5760",
            "fax_number": "414-259-9115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDTLING",
        "first_name": "MATTHEW",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-30",
        "last_updated": "2014-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "7269",
            "primary": true
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "WI",
            "license": "7269",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497098255",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Savannah Mickesh, APN
• Dara J Mickschl, PA-C
• Mid America Healthcare Corp of Wisconsin
• Mid-South Home Care Services, LLC
• Middle Coast Therapy LLC
• Midtown Pharmacy SC
• Midwest Adult Home Care LLC
• Midwest Anesthesia Consultants SC
• Midwest Area Physicians, LLC
• Midwest Community Services, Inc.

• Oral and Maxillofacial Surgery (Dentist) in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.